There has been enormous progress in the treatment of childhood cancer in the developed world and the epidemiology in these countries is well described. Hitherto, there has been no attempt to systematically study the burden of childhood cancer in India or to understand how the occurrence and outcome of the disease varies across the country. We have reviewed the epidemiology (incidence, survival, and mortality) of childhood cancer across different population-based cancer registries in India and also compared it with data from the resource-rich countries. Incidence and mortality data were obtained from the National Cancer Registry Program Reports and the Cancer Incidence in 5 Continents publications. Further, a comprehensive review of medical literature was done for information on individual cancers as well as survival data. 1.6 to 4.8% of all cancer in India is seen in children below 15 years of age and the overall incidence of 38 to 124 per million children, per year, is lower than that in the developed world. The considerable inter-regional variation in incidence and mortality rates across India suggests a possible deficiency in ascertainment of cases and death notification, particularly in rural areas. The marked male preponderance of Hodgkin's disease, lower incidence of central nervous system tumors, and higher incidence of retinoblastoma merit further analysis.

Soft tissue sarcomas (STSs) are rare and histologically diverse neoplasms. Recent results of various meta-analyses and development of newer drugs have changed the medical management of soft tissue sarcoma. This review gives an outline of chemotherapy and the newer targeted therapies for the same. We have carried out an extensive search in PubMed, Medline for almost all relevant articles concerning chemotherapy of soft tissue sarcoma. The available data from the literature is mainly composed of the most recent reviews, meta-analyses, phase II, and randomized phase III trials published in various peer reviewed journals and various international conferences. The role of neoadjuvant and adjuvant chemotherapy has been found to be controversial. The recent meta-analysis for adjuvant therapy in STSs has shown an increase in the overall survival with combination of ifosfamide and adriamycin. In locally advanced and metastatic STSs, single agent adriamycin remains the basic standard of medication. The combination of ifosfamide and adriamycin may also be used for rapid symptom relief and in patients planned for curative resection for metastases. Newer combinations of docetaxel and gemcitabine appear promising in selected subgroups, especially in leiomyosarcoma and malignant fibrous histiocytoma. Some recent developments include the European Union's approval of trabectedin for advanced STSs patients who had progressed on adriamycin and ifosfamide therapy. The future of mTOR inhibitors, insulin like growth factor receptor inhibitors and anti-angiogenic drugs appear quite promising. Newer methodologies such as, Bayesian adaptive randomization and inclusion of newer end points like progression-free rate, time of progression rate, and tumor growth rate will improve the results of sarcoma trials. At the end of each section we have also presented recommendations from *European Society of Medical Oncology and **National Comprehensive Cancer Network guidelines v.1.2009 for better correlation with the present literature.

Background: Free radical Injury is associated with cancer, but how the extent of oxidative stress correlates with the FIGO (International Federation of Gynecology and Obstetrics) stage in Carcinoma Cervix (Ca Cx), and its significance as a prognostic marker, is not clear and needs an in-depth study. Aim: To correlate the blood levels of Lipid Peroxidation (LPO), Reduced Glutathione (GSH), Superoxide Dismutase (SOD), and Vitamin A and E levels with the clinical stage in Ca Cx. Settings and Design: This is a Prospective Case Control Study. Materials and Methods: LPO, SOD, reduced GSH were estimated by Bio Chemical Assays and Vitamins by High Performance Liquid Chromatography (HPLC). Statistical Analysis: The cases and controls were compared using One Way ANOVA and different stages over different time periods were individually compared by Repeated Measure Analysis of Variance. Results: The results indicated a statistically significant increase of LPO vis-a-vis the FIGO stage of Ca Cx and control, while the antioxidant status as depicted by GSH and SOD decreased. Vitamin A and E levels were significantly lower in cancer cases as compared to the control. Conclusion: Increased LPO and reduced antioxidant levels may be taken as associated predictive markers, thus suggesting that Ca Cx cases should get nutritive supplements to contain the blood LPO level and maintain a positive balance of antioxidants for a better outcome in terms of delayed recurrence and better Quality of Life (QOL).

Exercising is one of the three cornerstones in the treatment of lymphedema together with contention mechanisms and lymphatic drainage. The aim of the current study was to evaluate a new method of mechanic lymphatic drainage. Volumetric reductions were evaluated after passive exercises in 25 patients with arm lymphedema resulting from breast cancer treatment. Their ages ranged between 42 and 86 years old. All patients were submitted to one-hour sessions using the RAGodoy® electromechanical apparatus which performs from 15 to 25 elbow bending and stretching exercises per minute. Volumetry, using the water displacement technique, was performed before and after the sessions. The paired t-test was employed for statistical analysis with an alpha error of less than 5% being considered acceptable. The reduction in volume was significant (P-value < 0.001) with a mean initial volume of 2026.4 and final volume of 1967.2 giving a mean loss of 59.2 mL. The RAGodoy® apparatus was efficient to reduce the volume of lymphedematous arms and is an option for the treatment of lymphedema.

Background : Cisplatin-induced ototoxicity shows high interindividual variability and is often accompanied by transient or permanent tinnitus. It is not possible to identify the susceptible individuals before commencement of the treatment. We conducted a prospective, randomized and observational study in a tertiary care centre and evaluated the effects of different doses of cisplatin on hearing. Materials and Methods : Fifty-seven patients scheduled for cisplatin-based chemotherapy were included in the study. All patients were divided into three groups depending on the dose of cisplatin infused in 3 weeks. Results : The subjective hearing loss was found in seven patients, while six patients had tinnitus during the chemotherapy. The hearing loss was sensorineural, dose dependent, symmetrical, bilateral and irreversible. Higher frequencies were first to be affected in cisplatin chemotherapy. Conclusion : As use of high-frequency audiometry is still limited in research work only, we need a strict protocol of adding high-frequency audiometry in the cisplatin-based chemotherapy regimen.

Pancreatic cancer is a devastating disease with a dismal prognosis and early detection remains a challenge. On the background that inflammation is one of the key steps in the development of cancer, it is natural that chronic pancreatitis is considered as one of the etiological factors for the development of pancreatic cancer. However, the process of pancreatic carcinogenesis is a multifactorial phenomenon rather than a process that evolves solely via inflammation. This review attempts to put into perspective the association between different etiological forms of chronic pancreatitis and pancreatic cancer, and the diverse mechanisms operational in the process of pancreatic carcinogenesis. Furthermore, the clinical relevance of the current understanding of the relationship between chronic pancreatitis and pancreatic cancer, especially with regard to the pancreatic head mass of uncertain etiology, is discussed in this review.

Background: The product of Wilms' tumor suppressor gene (WT1), a nuclear transcription factor, regulates the expression of the insulin-like growth factor (IGF) and transforming growth factor (TGF) systems, both of which are implicated in breast tumorigenesis and are known to facilitate angiogenesis. In the present study, WT1 allelic integrity was examined by Loss of Heterozygosity (LOH) studies in infiltrating breast carcinoma (n=60), ductal carcinoma in situ (DCIS) (n=10) and benign breast disease (n=5) patients, to determine its possible association with tumor progression. Methods: LOH at the WT1 locus (11p13) as determined by PCR-RFLP for Hinf1 restriction site and was subsequently examined for its association with intratumoral expression of various growth factors i.e. TGF-β1, IGF-II, IGF-1R and angiogenesis (VEGF and Intratumoral micro-vessel density) in breast carcinoma. Results: Six of 22 (27.2%) genetically heterozygous of infiltrating breast carcinoma and 1 of 4 DCIS cases showed loss of one allele at WT1 locus. Histologically, the tumors with LOH at WT1 were Intraductal carcinoma (IDC) and were of grade II and III. There was no correlation in the appearance of LOH at WT1 locus with age, tumor stage, menopausal status, chemotherapy status and lymph node metastasis. The expression of factor IGF-II and its receptor, IGF-1R was significantly higher in carcinoma having LOH at WT1 locus. A positive correlation was observed between the TGF-β1, VEGF expression and IMD scores in infiltrating carcinoma. Conclusions: The current study indicates that the high frequency of loss of allelic integrity at Wilms' tumor suppressor gene-1 locus in high-graded breast tumors is associated with aggressiveness of the tumor.

Background: Cancer data from Rajasthan are limited. Only two studies, one from Western Rajasthan, and the other from Eastern Rajasthan have been published by Sharma et al. in 1992 and 1996. Aims: To put the cancer profile from this region in proper perspective, we conducted the present study on the patterns of various malignancies in Jaipur region, i.e., Eastern Rajasthan. Setting and Design and Material and Methods: The study spans over one and half decade (1990-2004) and is based on a retrospective six-year sample analysis of approximately 200,000 histopathological and cytological reports for the years 1990, 1991, 1996, 1999, 2001 and 2004. Results: A total of 21,868 cancers were recorded in the six sample years. There were 59.11% (12,926) males and 40.89% (8942) females, with the male to female ratio being 1.45:1. Organ wise, lung (8.45%), prostate (7.12%), brain (6.04%), urinary bladder (5.31%), esophagus (4.67%) and tongue (4.60%) are most common sites involved in males with regard to frequency, whereas breast (20.44%), cervix (14.99%), ovary (4.35%), brain (3.80%), esophagus (3.67%), uterus (3.01%) and rectum (2.80%) are common sites for malignancies in females. Conclusions: Significant findings were a higher frequency of cancers of the prostate, urinary bladder, and brain in males along with gall bladder cancers in females. Our figures have been compared with the national data.

Background: Infection is a common cause of morbidity and mortality in cancer patients. In most of these cases empirical treatment is provided because the focus of infection is not identified. Empiric antibiotics provided to these patients are based on isolates, sensitivity, and on guidelines. Here we have compared three antibiotics recommended as empirical treatment by the Infectious Disease Society of America (IDSA). Aims: To compare the three antibiotic sensitivities for gram negative isolates at our institute. Objective: To choose the optimal antibiotic as the empirical treatment for cancer patients developing infections. Materials and Methods: We collected the data on isolates and antibiotic sensitivity patterns of isolates for ceftazidime, piperacillin + tazobactum, and cefoperazone from the medical oncology department. We subsequently compared the sensitivity of these three antibiotics. Statistical Methods: The isolates were mapped using the WHONET 5.4 software. The analysis was conducted using SPSS 15.0 for Windows. McNemar Chi-square test was used to compare the sensitivity percentages between any two antibiotics. The agreement between the antibiotic and the gold standard was calculated using the Kappa statistic. Two tailed p values were reported. Results: The results showed that there was a difference among sensitivities for these antibiotics. It appears that the sensitivity of ceftazidime was inferior to the two other antibiotics. Also cefoperazone has better sensitivity as compared to piperacillin + tazobactum. Conclusion: In spite of these three antibiotics being recommended by IDSA our data suggest that it should not be followed blindly and local sensitivity data is important for formulating institutional guidelines for using antibiotics.

Objective: This study was done to assess the prevalence of cancer chemotherapy-induced osteoporosis among survivors of cancer in Saudi Arabia. Material and Methods: Patients who received chemotherapy due to malignant disease attending oncology and orthopedic clinics between June 1, 2006 and November 30, 2006, were the subjects. Age, sex, type of malignancy, last chemotherapy cycle and body mass index (BMI) of patients were entered in the database. Complete blood picture, serum calcium, phosphorous, renal function and liver function tests were done. Bone mineral density measurement of the hip and spine was done using Dual-Energy X-ray Absorptiometry. Results: We analyzed the data of 71 patients with an average age of 49.29 ± 8.24 years. Of these, 19 (25.8%) were osteoporotic and 33.87% were found to be osteopenic according to the BMD of the lumbar spine, 17 (22.6%) found to be osteoporotic and 29% found to be osteopenic per the BMD of the hip area. Patients whose BMD was normal had received their last chemotherapy cycle 48.68 ± 27.35 months earlier (P = 0.01). Osteopenia and osteoporosis were more common in patients in the age group of ≤50 years (65.6%) versus 56.4% in patients of ≥51 years (P = 0.001). Patients who received the last cycle of chemotherapy of less than 2 years were significantly more osteoporotic (81.5%-18.5%, P < 0.0001). Conclusions: Our study indicates a high prevalence of osteopenia and osteoporosis in patients who were younger than ≤50 years and who had received cancer chemotherapy. Second, bone loss continued for more than 2 years from the last cycle of chemotherapy.

Analysis of binding energy activity of imatinib and Abl tyrosine kinase domain based on simple consideration for conformational change: An explanation for variation in imatinib effect in mutated typeV WiwanitkitOctober-December 2009, 46(4):335-336DOI:10.4103/0019-509X.55555 PMID:19749465

Imatinib is a clinically well-tolerated small molecule inhibitor that exerts selective, dual inhibition on the transforming growth factor beta and platelet-derived growth factor pathways. The recognition of an inactive conformation of Abl, in which a catalytically important Asp-Phe-Gly motif is flipped by approximately 180 degrees with respect to the active conformation, underlies the specificity of the cancer drug imatinib, which is used to treat chronic myelogenous leukemia. However, conformational analysis shows that the effect of the drug depends on the potential energy, which varies due to the alpha rotatable angles of the Abl tyrosine kinase domain. In this study, the author determines the change of binding energy between the Abl tyrosine kinase domain, due to the variation in rotatable angles, and bond lengthening. According to this study, the ratio between the required binding energy between the wild and mutated types is equal to 1: 1.16.